Inflammatory myofibroblastic tumor ofabdomen: computerized tomographic (CT) and pathological findings.

Inflammatory Myofibroblastic Tumor (IMT) is the recent name of Inflammatory pseudotumor which was in intermediate group of fibrous-origin tumor. The authors retrospectively reviewed such cases in Ramathibodi Hospital from January 2001 to December 2005. There were 115 cases of fibrous-origin tumor which was IMT in 17 cases. Nine cases occurred in the abdomen and only 3 of these had complete computerized tomographic (CT) imaging. One was hypodense liver mass with thick rim enhancement. Another one in the liver presented as a liver abscess which appeared as multiloculated hypodense mass with enhanced septum. The third case was a large malignant-looking retroperitoneal mass and having a small accompanying hepatic lesion which rapidly grew in the follow up study at nine months. IMT in the abdomen was scanty. The diagnosis was done with difficulty because of different signs and symptoms such as fever and palpable abdominal mass. The laboratory findings were nonspecific or within normal limits. Tissue biopsy was the way of definite diagnosis. We reported 3 cases of abdominal IMT with variable imaging findings that may lead to inappropriate treatment. Recognization of such findings will help achieve correct diagnosis.

Including MIR of a primary bone leiomyosarcoma that radiologically mimics a giant cell tumor.

The authors present a case of a 42-year-old female who developed a leiomyosarcoma of the right proximal tibia that appeared radiologically similar to a giant cell tumor Histology revealed spindle cells running in whorl-like fashion with focal atypia and low mitotic figures. The immuno-stains revealed positive reactivity for alpha-smooth muscle (SMA), muscle actin and cytokeratin (AE1/AE3). The authors rendered a diagnosis of low-grade leiomyosarcoma of bone. The lesion was considered a primary lesion since the patient did not have other leiomyomatous tumors. The MRI showed hypo- to iso- signal intensity on T1-weighted imaging and heterogeneous intensity on T2-weighted imaging. This was likely due to admixed fibrotic tissue in the lesion. The tumor cells were not positive for Ebstein-Barr virus by in-situ hybridization as seen in leiomyomatous tumors in immunodeficiency patients.

Invasive fungal infection in Ramathibodi Hospital: a ten-year autopsy review.

OBJECTIVE: Determine the clinicopathological findings in autopsy cases with invasive fungal infection. MATERIAL AND METHOD: The autopsy and medical records with invasive fungal infection in Ramathibodi Hospital between January 1997 and December 2006 were analyzed. The criterions for the diagnosis of invasive fungal infection were the evidence of fungal elements from histopathological section. The age, gender underlying predisposing risk factors for the disease, clinical manifestations, extent of systemic organ involvement documented morphologically at autopsy, and fungal culture were analyzed RESULTS: There were 155 autopsy cases (73 male, 82 female; mean age 45.3 years, range 3 months to 87 years) with the diagnosis of invasive fungal infection. The common clinical presentations were fever (55.5%), and dyspnea (26.5%). The invasive fungal infection was associated with hematologic malignancy in 31%. The common mycoses were aspergillosis and candidiasis, which were observed in 88 and 80 cases, respectively. There were 32 cases (20.6%) of mixed fungal infection. Cultures from autopsy materials were positive for fungus in 80 cases out of 99 cases (80.8%). The most frequent site of fungal infection was in the lungs (74.8%), followed by gastrointestinal tract (28.4%), and brain (26.5%). Invasive fungal infection was diagnosed intravitally in 63.9% of total cases. CONCLUSION: A diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompromised patients who presented with prolonged fever Clinical specimens must be sent for histopathology and fungal culture for a definite diagnosis and an appropriate management. Therefore, the physician should inform the laboratory if invasive fungal infection is suspected because special media are necessary for the best recovery of fungi. In addition, the present study underscores the significance of autopsy as a diagnostic method and means of medical quality control.

An intramuscular cysticercosis, a case report with correlation of magnetic resonance imaging and histopathology.

The authors report a case of a solitary intramuscular cysticercosis in a 47-year-old female who presented with a mass in the right elbow for five years. The magnetic resonance imaging (MRI) findings revealed a cystic mass of 1.5 cm. in size located at the periphery of the pronator teres muscle; the T1-weighted MRI showed hypointensity mass with internal content that was more obviously seen on T2-weighted image and T1-weighted with fat suppression after gadolinium administration. The authors could not recognize perilesional edema in the MRI that corresponded with the histological findings of chronic inflammatory process in combination with foreign body giant cell reaction. The scolex could not be seen in the imaging but could be identified in the histopathological sections.

A descriptive study of 36 cases of solitary soft tissue cysticercosis at Ramathibodi Hospital from surgical specimens during 1990-2006.

We present a study of 36 cases of solitary soft tissue cysticercosis retrieved from pathological reports and medical records during 1990-2006. The soft tissue was the most common organ affected by cysticercosis in our study accounting for 75% of all affected cases. The brain was the second most common, and accounted for 15%. The most common location for the soft tissue lesions was upper extremities which accounted for 33% of cases, and the least common sites were the back, eyelid, buttock and cheek, which accounted for 3% each. Preoperative diagnoses of the lesions were as follows: lipoma, masses of undetermined nature, cysts, abscesses, fat necrosis and lymphadenitis. The mean size of lesions was 1.5 cm; the minimum and maximum sizes were 0.3 and 3 cm, respectively. The mean age of the patients was 33.5 years and the range was 9 to 68 years. The ratio of males to females was 1 to 5, which may reflect differences in eating habits and social life between males and females in our society. Our findings indicated that none of the cases in our study were diagnosed as cysticercosis preoperatively. Therefore, clinicians should include cysticercosis in the differential diagnosis of soft tissue cystic nodules or masses. Data regarding the sizes of lesions should be helpful in differentiating this entity from other soft tissue lesions in clinical practice and on magnetic resonance imaging.

Giant cell reparative granuloma concurrent with squamous cell carcinoma of the temporal bone: a case report and review of the literature.

A case of giant cell reparative granuloma concurrent with squamous cell carcinoma of the right temporal bone in a 44-year-old man with clinically presenting otorrhea from the mass of the right acoustic canal with hearing loss is reported. The histopathological examination of the lesion characterizes by multinucleated giant cells with in a fibroblastic stroma and area of keratinizing squamous cell carcinoma. GCRG may have been a local reaction provoked by the squamous cell carcinoma. Clinical and pathological features with briefly reviewed relevant literatures of temporal GCRG describing 24 cases are discussed. The patients have the mean age of 34.8 years. The ages of the patients ranged from 4 months to 72 years old. Temporal bone GCRG shows a male predilection of approximately 3:1. The frequently presenting symptoms of temporal bone GCRG are hearing loss, mass, tinnitus, otalgia, otorrhea, vertigo, headache, facial weakness, and diplopia. This is the first reported description in the literature of temporal bone GCRG concurrent with squamous cell carcinoma.

Normal internal organ weight of Thai adults correlated to body length and body weight.

OBJECTIVE: Examine the relationship between the internal organ weight with body weight and body length. MATERIAL AND METHOD: Analysis of data from 250 autopsies from the Ramathibodi Hospital from August 2003 to February 2005. The cases were from sudden unnatural death including accident, homicide and suicide and excluded decomposed bodies, fire related deaths and cases where medical treatment had been given. The age ranged from 15 to 88 years and there were 51 females and 199 males. Parson's correlation coefficient was used to examine the relationship between the internal organ weight with body weight and body length. RESULTS: The mean+/-standard deviation (SD) were represented by males and females respectively; Brain 1339+/-160/1165+/-184 gm, heart 311+/-66/278+/-160 gm, lung 910+/-347/675+/-255 gm, liver 1439+/-365/ 1214+/-275 gm, spleen 103+/-46/92.9+/-48 gm, kidney 260+/-68/230+/-42 gm. CONCLUSION: The relationship between internal organ weight and body weight showed each internal organ significantly correlated with body weight in males at p-value < 0.05, whereas in females it only correlated to liver, kidney and spleen at p-value < 0.05. For the correlation between internal organ weight and body length, it showed only brain, lung, liver and kidney correlated to the body length in males at p-value < 0. 05, but not in females.

Epstein-Barr virus associated lymphoepithelial carcinoma of the parotid gland; a clinicopathological report of three cases.

Lymphoepithelial carcinoma is a relatively uncommon malignant tumor of the salivary gland demonstrating malignant epithelial cells with dense lymphoid stroma. The authors report three cases of lymphoepithelial carcinoma associated with Epstein-Barr virus of the right parotid gland with clinically presenting as painless, gradual enlargement of the preauricular mass. The histopathologic examination of the parotid gland is characterized by malignant epithelial cells with dense lymphoid stroma. Immunohistochemical stains show positive reactivity to cytokeratin and p53 in malignant epithelial cells. In situ hybridization of the Epstein-Barr virus-encoded Ribonucleic acid shows positivity in malignant epithelial cells. Clinical and pathologic features with relevant literatures are discussed. These are the first reported cases of primary parotid lymphoepithelial carcinoma associated with Epstein-Barr virus infection in Thailand and Southeast Asia.